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Antimicrobial Agents and Chemotherapy, January 2003, p. 196-203, Vol. 47, No. 1
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.1.196-203.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Comparative Molecular Analysis of Community- or Hospital-Acquired Methicillin-Resistant Staphylococcus aureus

P. D. Fey,1,2* B. Saïd-Salim,3 M. E. Rupp,1 S. H. Hinrichs,2 D. J. Boxrud,4 C. C. Davis,5 B. N. Kreiswirth,3 and P. M. Schlievert6

Department of Internal Medicine,1 the Nebraska Public Health Laboratory, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska,2 Acute Disease Epidemiology Section and the Division of Public Health Laboratories, Minnesota Public Health Laboratory,4 Department of Microbiology, University of Minnesota Medical School, Minneapolis, Minnesota,6 FemCare Microbiology Product Safety and Regulatory Affairs, The Procter & Gamble Company, Cincinnati, Ohio,5 Public Health Research Institute, Newark, New Jersey3

Received 22 July 2002/ Returned for modification 2 September 2002/ Accepted 21 October 2002

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a growing public health concern that has been associated with pediatric fatalities. It is hypothesized that the evolution of CA-MRSA is a recent event due to the acquisition of mec DNA by previously methicillin-susceptible strains that circulated in the community. This study investigated the genetic relatedness between CA-MRSA, hospital-associated MRSA (HA-MRSA), and nonmenstrual toxic shock syndrome (nmTSS) isolates. Thirty-one of 32 CA-MRSA isolates were highly related as determined by pulsed-field gel electrophoresis and spa typing yet were distinguishable from 32 HA-MRSA strains. The 31 related CA-MRSA isolates produced either staphylococcal enterotoxin B (n = 5) or C (n = 26), and none made TSS toxin 1. All CA-MRSA isolates tested contained a type IV staphylococcal cassette chromosome mec (SCCmec) element. In comparison, none of the HA-MRSA isolates (n = 32) expressed the three superantigens. Antibiotic susceptibility patterns were different between the CA-MRSA and HA-MRSA isolates; CA-MRSA was typically resistant only to ß-lactam antibiotics. Six of twenty-one nmTSS isolates were indistinguishable or highly related to the CA-MRSA isolates. MnCop, an nmTSS isolate obtained in Alabama in 1986, was highly related to the CA-MRSA isolates except that it did not contain an SCCmec element. These data suggest that CA-MRSA strains may represent a new acquisition of SCCmec DNA in a previously susceptible genetic background that was capable of causing nmTSS. CA-MRSA poses a serious health risk not only because it is resistant to the antibiotics of choice for community-acquired staphylococcal infections but also because of its ability to cause nmTSS via superantigen production.

* Corresponding author. Mailing address: University of Nebraska Medical Center Departments of Internal Medicine and Pathology and Microbiology, 985400 Nebraska Medical Center, Omaha, NE 68198-5400. Phone: (402) 559-2122. Fax: (402) 559-5581. E-mail: pfey{at}unmc.edu.

Antimicrobial Agents and Chemotherapy, January 2003, p. 196-203, Vol. 47, No. 1
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.1.196-203.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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